Mayo Clinic-Arizona, Department of Orthopedic Surgery, Phoenix, AZ.
University of Arizona College of Medicine-Phoenix, Orthopedic Surgery Residency, Phoenix, AZ.
Spine (Phila Pa 1976). 2018 May 1;43(9):661-666. doi: 10.1097/BRS.0000000000002397.
A retrospective cohort study.
The aim of this study was to evaluate the effect of metabolic syndrome (MetS) on 30-day morbidity and mortality following elective lumbar spinal fusion.
MetS is a variable combination of hypertension, obesity, elevated fasting plasma glucose, and dyslipidemia.MetS has been associated with an increased risk of postoperative morbidity and mortality in multiple surgical settings. To our knowledge, the effect of MetS on 30-day outcomes following elective lumbar spinal fusion has not been well studied.
An analysis of ACS-NSQIP data was performed between 2006 and 2013. Patients undergoing elective posterior lumbar fusion were identified. Emergency procedures, infections, tumor cases, and revision surgeries were excluded. Patients were defined as having MetS if they had a history of hypertension requiring medication, diabetes, and a body mass index (BMI) ≥30 kg/m.
One thousand five hundred ninety (10.2%) patients with MetS were identified. A mild increase in major (P = 0.040) and minor complications (P = 0.003) in patients with MetS was noted. MetS was associated with increased rates of pulmonary complications (1.9% compared with 1.0%; P = 0.001), sepsis (1.7% compared with 0.9%; P = 0.005), and acute post-op renal failure (0.4% compared with 0%; P < 0.001). Multivariate analysis confirmed MetS to be an independent predictor of pulmonary complications [odds ratio (OR) 1.51; 95% confidence interval (95% CI 1.00-2.27); P = 0.048], sepsis (OR 1.56; 95% CI 1.01-2.42; P = 0.039), and acute postoperative renal failure (OR 6.95; 95% CI 2.23-21.67; P = 0.001). MetS status was associated with a mild increase in total hospital length of stay (4.38 compared with 3.81 days; P < 0.001).
While MetS is a predictor of postoperative acute renal failure, it only slightly increases the risk of overall complications and is not associated with increased rates of 30-day reoperations or readmissions following elective lumbar fusion.
回顾性队列研究。
本研究旨在评估代谢综合征（MetS）对择期腰椎融合术后 30 天发病率和死亡率的影响。
MetS 是高血压、肥胖、空腹血糖升高和血脂异常等多种变量的组合。MetS 已与多种手术环境中的术后发病率和死亡率增加相关。据我们所知，MetS 对择期腰椎融合术后 30 天结果的影响尚未得到很好的研究。
对 2006 年至 2013 年 ACS-NSQIP 数据进行了分析。确定了接受择期后路腰椎融合术的患者。排除急症手术、感染、肿瘤病例和翻修手术。如果患者有高血压需要药物治疗、糖尿病和 BMI≥30kg/m 的病史，则将其定义为患有 MetS。
确定了 1590 例（10.2%）患有 MetS 的患者。患有 MetS 的患者主要（P=0.040）和次要并发症（P=0.003）略有增加。MetS 与肺部并发症（1.9%比 1.0%；P=0.001）、败血症（1.7%比 0.9%；P=0.005）和急性术后急性肾功能衰竭（0.4%比 0%；P<0.001）发生率的增加有关。多变量分析证实 MetS 是肺部并发症的独立预测因素[比值比（OR）1.51；95%置信区间（95%CI 1.00-2.27）；P=0.048]、败血症（OR 1.56；95%CI 1.01-2.42；P=0.039）和急性术后急性肾功能衰竭（OR 6.95；95%CI 2.23-21.67；P=0.001）。MetS 状态与总住院时间延长（4.38 天比 3.81 天；P<0.001）轻度相关。
虽然 MetS 是术后急性肾功能衰竭的预测因素，但它仅略微增加了总体并发症的风险，与择期腰椎融合术后 30 天再次手术或再入院率增加无关。
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